Which airway adjunct is appropriate for a patient with AMS and intact gag reflex?

• A. Endotracheal tube
• B. Oropharyngeal airway
• C. Laryngeal mask airway
• D. Nasopharyngeal airway

Answer: (D)

When a patient has altered mental status but their gag reflex is intact, the goal is to keep the airway open with a device that won’t provoke the protective reflexes. A nasopharyngeal airway fits this need because it slides in through the nose and sits in the pharynx, helping to keep the airway open without stimulating the oropharynx as much as an oropharyngeal airway would. An oropharyngeal airway is avoided when the gag reflex is present due to the risk of triggering gagging or vomiting. An endotracheal tube provides a definitive airway but is more invasive and not warranted unless ventilation becomes a concern or the patient cannot protect their airway. A laryngeal mask airway can be used in some settings, but it still carries a risk of irritation and aspiration in a semi-conscious patient with intact reflexes. Remember to avoid a nasopharyngeal airway if there is nasal trauma or suspected basal skull fracture.